MEDICARE: ELVIA ROSA OBREGON-MENDOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	59612	TX

General Provider Information

NPI Number	:	1396476651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIA ROSA OBREGON-MENDOZA

Provider Business Mailing Address
First Line	:	5606 SPRING MOON ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1950
Country	:	US
Telephone Number	:	210-488-1494
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 SPRING MOON ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1950
Country	:	US
Telephone Number	:	210-488-1494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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